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Stuttering Lecture 5: An Overview of the Development of Stuttering, Normal Disfluency, and the Course of Stuttering Development
Terms in this set (41)
-Distinguish between normal disfluency and stuttering
-Evaluate core behaviors, secondary behaviors, feeling & beliefs, stressors (whole lot of things to look at before diagnosis)
-Address questions and concerns from parents
-Formulate a therapeutic program to address issues
-Implement patient-specific treatment regimen to overcome obstacles
Stuttering or Normal Disfluencies?
-Wait and see?
-Will he be OK or ...?
(recover without intervention, but unlikely)
Let's look at what ASHA says (handout)
All speakers produce disfluencies, which may include hesitations, such as silent pauses, and interjections of word fillers (e.g., "The color is like red") and nonword fillers (e.g., "The color is uh red"). Other examples include whole-word repetitions (e.g., "But-but I don't want to go") and phrase repetitions or revisions (e.g., "This is a- this is a problem"). These are generally considered to be nonstuttered (typical) disfluencies (Ambrose & Yairi, 1999; Tumanova, Conture, Lambert, & Walden, 2014). When a child uses a high number of nonstuttered (typical) disfluencies, differential diagnosis is critical to distinguish between stuttering, avoidance, and a language disorder.
Practice Portal cont.
Stuttering typically has its origins in childhood. Most children who stutter, begin to do so around 2 ½ years of age (e.g., Mansson, 2007; Yairi & Ambrose, 2005; Yaruss, LaSalle, & Conture, 1998). Approximately 95% of children who stutter start to do so before the age of 5 years (Yairi & Ambrose, 2005).
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Less typical, stuttering-like disfluencies (Yairi, 2007) include part-word or sound/syllable repetitions (e.g., "Look at the b-b-baby"), prolongations (e.g., "Ssssssssometimes we stay home"), and blocks (i.e., inaudible or silent fixations or inability to initiate sounds). In addition, compared with typical disfluencies, stuttering-like disfluencies are usually accompanied by greater than average duration, effort, tension, or struggle. Aspects that factor into perception of severity include frequency and type of stuttering and the ability of the person who stutters to communicate effectively.
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Some young children go through a period of excessive disfluency, which does not persist for a large majority of these children. Estimates of remission vary from 6.3% (Reilly et al., 2013) to 47% (Fritzell, 1976) to 89% (Yairi & Ambrose, 1992, 1999; Yairi, Ambrose, Paden, & Throneburg, 1996). The large variability in recovery estimates may be due to factors such as the way the data were collected (e.g., individual, clinic, or community) and the age at which recovery was determined (Reilly et al., 2013).
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Stuttering can greatly interfere with school, work, or social interactions (Yaruss & Quesal, 2004). Children who stutter may report fear or anxiety about speaking and frustration or embarrassment with the time and effort required to speak (Ezrati-Vinacour, Platzky, & Yairi, 2001). Children who stutter may also be at risk for experiencing bullying (Blood & Blood, 2004; Davis, Howell, & Cooke, 2002; Langevin, Bortnick, Hammer, & Wiebe, 1998).
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Stuttering can co-occur with other disorders, such as speech sound disorders (St. Louis & Hinzman, 1988; Wolk, Edwards, & Conture, 1993); intellectual disabilities (Healey, Reid, & Donaher, 2005); and language disorders (Ntourou, Conture, & Lipsey, 2011). For example, although there is little systematic evidence describing disfluency in autism spectrum disorder (ASD), increasing numbers of case reports indicate both stuttering-like disfluency and non-stuttered (typical) disfluency (Scaler Scott, Tetnowski, Flaitz, & Yaruss, 2014) and atypical disfluency that is additionally distinguished by unusual features, such as repetition of final segments of words (Paul et al., 2005; Shriberg et al., 2001; Sisskin & Wasilus, 2014).
Fill out Stuttering or Normal Disfluencies worksheet in your packet
provide three reasons for her normal disfluencies:
1. whole word repetitions
2. no secondary behaviors, not a lot of tension
3. no blocks or prolongations, no evidence of core behaviors
-normal interjections, but when they start to use them to avoid
-no eye contact
-part word repetitions
-tension in face
-moving her jaw
1. Frequency of disfluency
2. Number of units of repetitions and interjections
3. Type of disfluency
-CWS have about twice as many disfluencies (mean = 18/100 words)
-Normal speaking children averaged 7/100 words
-3.5 year old and get frequency data and she turns out to have 7.5% disfluencies
-not enough to be called a stutterer
-don't label them a stutterer based on this alone!
-you can have a normal speaker who has a high frequency of disfluencies, and can still not be a stutterer (probability goes up, but don't jump to conclusions)
Criteria: 10 or fewer per 100 words
-likely to be normal
-if more than 10%: more likely to be a stutterer
>3% words stuttered
-percent of words stuttered
-part word, prolongations and blocks
-subgroup of larger group of disfluencies
-typical kids will have some, but there is not many
-if child stutters on more than 3% of words, that is an indication that they are likely to be a stutterer
Number of Units Repeated
Normal: One extra unit
(average = 1.13)
-one extra word or sound
Stuttering: Two or more
(average = 1.51)
Criteria: Two units of repetition = stuttering
Types of Disfluencies
-Single-syllable word repetition: the the the
-Multi-syllabic word repetition: cookie cookie cookie
Disfluency Characteristics in a Non-Stuttering Child
-Interjections, revisions, word repetitions most common [Revisions account for major portion]
-we see these often
-but not core behaviors
-some part word repetitions
-Decline in part-word repetitions after age 3
-Fewer than 2 units
-Involve longer units as
-Begin to stumble more on function words
Rarely secondary behaviors as not aware of disfluencies
-some children do get them, but they are not always there
-not all young children will have them as severely
-the absence of secondary behaviors doesn't mean the child has normal speech
Let's Look at Katie's Speech in Greater Detail
1. Frequency of Disfluencies
2. Units of Repetition
3. Types of Disfluencies
Katie's Disfluency Analysis
1. Frequency Disfluencies: 20.3%
-around 13/64 words
2. Types of Disfluency
-Single-Wd Rep (whole word)
3. Number of Extra Reps: 1-4
4. Other Features:
-don't count disfluencies when there is an unintelligible utterance
How concerned should we be?!
What level of stuttering is this?
-from beginning to more advanced
Levels or Stages of Stuttering
1. Normal Disfluency
2. Borderline Stuttering
3. Beginning Stuttering
4. Intermediate Stuttering
5. Advanced Stuttering
-once you identified the child is stuttering, what level is it?
Parameters of Stuttering
-Core Behaviors: Frequency & Type
-Secondary Behaviors: Awareness
-Feelings and Attitudes: Emotions
-Underlying Processes: Factors
(speech and language, motor, all capacities)
Characteristics of Normal Disfluency
-Frequency: 10 or fewer per 100 words
-Type: Mostly single-unit repetitions
-Factors: Demands of acquisition; speech-motor control; security & psychosocial issues (don't seem to have much play)
Characteristics of Borderline Stuttering
-Frequency: 11 or more per 100 words
-Type: More 'stuttering-like' disfluencies; 2 or more iterations per repetition
-more repetitions, more prolongations, etc.
-Awareness: Unaware -> loose, relaxed; surprise/frustration?
-Factors: Speech-language issues?; pressure higher rate, complexity, social
-maybe or maybe not
-think through those and see if present or not
Characteristics of Beginning Stuttering
-Frequency same (11% or greater)
-Type: Rapid, irregular, tense reps; may have fixed postures in blocks
-more tense, occasional blocks that are fleeting
-Awareness: Escape behaviors, pitch/ loudness increases
-in stuttering and want to get out
-might see secondary behaviors as they try to get out of the stutter (e.g., squeezing eyes)
-Factors: Conditioned emotional reactions; instrumental conditioning (escape behaviors)
Characteristics of Intermediate Stuttering
-Type: Blocks = sound stoppage, airflow occluded
-where blocks typically start to occur
-Awareness: Escape & avoidance behaviors; fear, frustration, embarrassment, shame
-also now want to avoid
-embarrassed, don't want to do it
-not going to talk or say other words instead, skip words
-Factors: All preceding plus avoidance conditioning
-A learned behavior implemented to diminish the likelihood that a stutter will occur
-Difficult to extinguish
-"um", "ya know, like.."
-intermediate: fear starts to come in
-so concerned with stuttering; they don't even want to go there
-word finding: won't see tension, related stuttering behaviors
Characteristics of Advanced Stuttering
-Type: Long blocks with tension
-Awareness: Escape & avoidance behaviors; emotions & integration into self-concept
-Affecting how they feel about themselves
-I just can't talk
-nobody likes me
-Factors: All preceding plus cognitive learning
-Complex, deeply-rooted system of behaviors
-Deeply-felt belief system
-Altered perceptions, projections
-avoid stuttering at all costs
-start to internalize shame and embarrassment with speech
Development of Core Behaviors
-Normal: Fewer than 10 percent disfluencies/100 words; single unit repetitions
-Borderline :<10 disfluencies/100 words; multi-unit repetitions; more repetitions than prolongations
-Beginning: Rapid irregular and tense repetitions; may have fixed articulatory postures in blocks
-Intermediate: Sound and airflow occluded during blockages
-Advanced: Long tense blocks; some with tremor
Development of Secondary Behaviors
-Beginning: Escape behaviors emerge
-Intermediate: Escape and avoidance behaviors
-Advanced: Escape and avoidance behaviors (more severe)
Development of Feelings and Attitudes
-Normal: Not aware or concerned
-Borderline: Minimal awareness; surprise or mild frustration?
-Beginning: Aware; may express frustration
-Intermediate: Fear, frustration, embarrassment, shame
-Advanced: All above; negative self-image and concept
Changes in Underlying Processes
-Normal: Stresses of sp/lang and psychosocial development
-Borderline: Stresses interact with congenital predisposition to being anxious, worried, etc.
-Beginning: Conditioned emotional reaction that causes tension; escape behaviors
-Intermediate: All above plus avoidance conditioning
-Advanced: All above plus cognitive learning (self image)
Characteristics of Five Developmental/Treatment Levels
Katie: What Level is her Stuttering?
-above 10% criteria
-she is aware
-A great deal of overlap exists: put everything together
-Exceptions to every 'rule'
-Stuttering is variable
-not clear cut!
-Studies have disagreed
-Mild to moderate loss not a protective factor
-not getting same auditory feedback
So, What Happened with Katie? 11.18.10 17 months later
-working on environment can make a huge difference for kids
Addressing Parent's Concerns
-Divide into groups of two
-One is the SLP. One is the parent
-The parent randomly selects questions The SLP answers.
-Together, look at suggested answers for each question to see how the SLP did.
-questions often asked by parents
-why does my child stutter?
SLP's Role again!
-Distinguish b/n normal disfluency and stuttering
-Evaluate core behaviors, secondary behaviors, feeling & beliefs, stressors
-Address questions and concerns
-Prescribe a therapeutic program to address
-Implement patient-specific treatment regimen to overcome obstacles
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